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There are some Canadians that have a certain clinic they like or doctor they like that is a tradition in going back and forth across the border with the United States. But according to the Canadian government, 85% of Canadians like the health care they are receiving in Canada. You don't see long lines of Canadians in health care clinics in Detroit.

A former Ontario health and economic minister notes that Canada spends more than a third less per capita on health than the United States and still covers "everyone," wheras the United States system leaves 47 million people without insurance. In Canada, doctors do not have to waste time seeking insurance approvals. Medical need is the only requirement, and pre-existing conditions don't matter.

When it comes to making coverage decisions based on medical evidence, for-profit insurers have a pretty spotty record. In the 1990s, when insurers said they were trying to "manage care," many were simply "managing costs." For example, some decided which drugs to include in their formularies based simply on whether the manufacturer would give them a deep discount. In return for the discount, the insurance company would assure the drug-maker that it would not cover a competing product. This had nothing to do with which drug was more effective.

The public will always be suspicious of decisions made by for-profit insurers even when their decisions are based on sound medical evidence. For-profit insurers just don't have the political or moral standing to make these judgments. By contrast, most patients are much more comfortable with Medicare's coverage decisions which is why we need a federal agency (MedPAC - an independent group that advises Congress, but give it some meat behind it) testing and comparing the effectiveness of new treatments.

Comparative research has the potential to tell us which drugs and treatments are safe, and which ones work. This is not information that the private sector will generate on its own, or that the "industry" wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government find out about it and use it.

Comparative-effectiveness research can help doctors and patients, through research, studies and comparisons, undertand which drugs, therapies and treatments work and which don't. Doctors will still have the ultimate decision, along with the patient.

If people begin talking about health care, they may begin to really think about it. It may even occur to them that perhaps it wouldn't be so terrible to borrow a few ideas from other countries. If another country builds a better car, we buy it (Toyota, Honda, Nissan). If they make a better wine, we drink it. If they have better healthcare ... what's our problem?

For those who still have health insurance and think you'll lose it with an "option" program, your premiums nearly doubled over the last eight years, and the health care system controlled costs by dropping coverage for many workers: a safety valve of uninsured to dump out of the system. If you can increase prices and have relatively inelastic demand (people forced to drop out), you'll find enough people stay paying into the system so that the total amount paid in goes up. Are you next?

In another five years, the $10,000 cost of family insurance will be $15,000, and more and more employers will have dumped people either into higher-deductible health plans or into the uninsured pool. This is really going to hurt before it'll create a constituency that will support universal health care. The increases in health care costs will have impacted virtually everyone.

In the meantime, your family doctor has to become an employee of your local hospital, instead of being independent. And you'll continue to have a corporate bureaucrat between you and your doctor.

Conservatives in and out of power, are doing everything they can to stand in the way of major reform. The right is taking its lead from GOP pollster Frank Luntz, who authored a memo laying out a rhetorical strategy for conservatives to demonize Obama's proposal.

In the memo, Luntz outlined the "script" for opponents of health care reform. He argued that a politician had to first pretend to support it, but should then use phrases like "government takeover," "delayed care is denied care," "consequences of rationing," and "bureaucrats, not doctors prescribing medicine." That jargon is routinely heard by conservatives arguing against reform.

Luntz recently admitted that he is urging conservatives to attack reform as a "government takeover" regardless of what the actural legislation coming from Congress says. Opponents of health care reform in Congress are proposing amendments that would maintain the status quo.

Wendell Potter worked in the health insurance industry for more than 20 years. He rose to be a senior executive at Cigna. He was on their calls, at their board meetings, in their books. He testified at a Senate Commerce Committe hearing.

The industry, Potter said, is driven by "two key figures: earnings per share and the medical-loss ratio, or medical-benefit ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits."

The best way to drive down "medical-loss," explained Potter, is to stop insuring unhealthy people. You won't, after all, have to spend very much of a healthy person's dollar on medical care because he or she won't need much medical care. And the insurance industry accomplishes this through two main policies. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment.

Rescission is important to the business model. At a hearing before the House Subcommittee on Oversight and Investigation, Rep. Bart Stupak, the committee chairman, asked three insurance industry executives if they would commit to ending rescission except in cases of intentional fraud. "No," they each said.

Potter also emphasized the practice known as "purging." This is where insurers rid themselves of unprofitable accounts by slapping them with "intentionally unrealistic rate increases." One famous example came when Cigna decided to drive the Entertainment Industry Group Insurance Trust in California and New Jersey off of its books. It hit them with a rate increase that would have left some family plans costing more than $44,000 a year, and it gave them three months to come up with the cash.

The issue isn't that insurance companies are evil. It's that they need to be profitable. They have a fiduciary responsibility to maximize profit for shareholders. Potter reasoned that we generally like markets because the profit incentive spurs useful innovations. But in some markets, that's not the case. We don't allow a bustling market in heroin, for instance, because we don't want a lot of innovation in heroin creation, packaging and advertising. Are we really sure we want a bustling market in how to cleverly revoke the insurance of people who prove to be sickly?

As a rule, the "profit" motive and "free" enterprise are hard to beat when it comes to systems for allocating resources in a free society, but some institutions like churches, education and healthcare are and should be exceptions to that rule.

So many people have a stake in the healthcare economy. With the wealth comes political clout and powerful influence over public awareness. If you so much as talk about reigning in doctors or drug companies or health insurance, you're branded as a advocate of socialized medicine.